Emergency department care for trauma patients in settings of active conflict versus urban violence: all of the same calibre?

This study examines Médecins Sans Frontières care in trauma emergency departments in Kunduz, Afghanistan and Tabarre, Haiti

From:: Department for International Development
Published: 16 November 2016

Country:: Afghanistan, Haiti
Document Type:: Journal Article
Theme:: Governance and Conflict, Health
Authors:: Vallesa, Pola, Van den Bergh, R, van den Boogaard, W, Tayler-Smith, K, Gayraud, O, Mammozaid, B.A, Nasimd, M, Cherestalc, S, Majustec, A, Charles, J.P, Trellesa, M

Abstract

Background

Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in 2 trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts.

Methods

A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in 2 EDs over the course of 2014.

Results

31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians’ maximum working capacity was exceeded in both centres, and mainly during rush hours.

Conclusions

This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.

This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)

Citation

Pola Vallesa, Rafael Van den Bergh, Wilma van den Boogaard, Katherine Tayler-Smith, Olivia Gayraud, Bashir Ahmad Mammozaid, Masood Nasimd, Sophia Cheréstalc, Alberta Majustec, James Philippe Charles, Miguel Trellesa (2016) Emergency department care for trauma patients in settings of active conflict versus urban violence: all of the same calibre? International Health 2016; 8: 390–397 doi:10.1093/inthealth/ihw035